Physician Suicide Linked to Work Stress

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Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems.

Point out that problems with work were three times more likely to have contributed to a physician's suicide than a nonphysician's.

Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems, a national analysis showed.

Problems with work were three times more likely to have contributed to a physician's suicide than a nonphysician's, Katherine J. Gold, MD, MSW, of the University of Michigan in Ann Arbor, and colleagues found.

Their analysis of the National Violent Death Reporting System also showed that known mental illness prior to suicide was 34% more common among physicians than nonphysicians.

"The results of this study paint a picture of the typical physician suicide victim that is substantially different from that of the nonphysician suicide victim in several important ways," the group wrote online in General Hospital Psychiatry.

"Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians."

The suicide rate is higher among physicians than in the general population, but there's not much reliable information as to why, Gold and her team pointed out.

"Even though this population presumably has very good access to healthcare, it doesn't appear that they're getting adequate treatment," Gold noted in a statement. "I think stigma about mental health is a huge part of the story. There is a belief that physicians should be able to avoid depression or just 'get over it' by themselves."

Fear that a depression diagnosis could hurt their medical licensing is common, and many physicians appear to avoid treatment completely in order to protect confidentiality about their mental health problems, based on prior surveys.

Gold and colleagues' study used the national database on violent deaths as a resource with "critical, and heretofore rarely-available" variables pulled from sources such as death certificates, toxicology, and reports from coroners, medical examiners, and law enforcement.

Among the 31,636 suicide victims included in the database from 2003 to 2008, 203 were physicians. Medical students and physician assistants were excluded from the analysis, although retired physicians were not.

Although physicians weren't significantly more likely to have a current mental health disorder (46% versus 41%) or to have current depressed mood (42% versus 39%) at the time of death than those in other occupations, the difference became significant on multivariate analysis: Having a known mental illness was modestly associated with physician status, with an odds ratio of 1.34 after adjustment for gender, race, age, and marital status (P=0.045).

Known alcohol or substance abuse were less common, though, among physicians (14% versus 23%, P=0.004). High blood alcohol levels on toxicology at the time of death were actually less common among physicians (OR 0.56, P=0.032).

Notably, physicians weren't significantly more likely to have antidepressants found on toxicology (OR 1.31, P=0.263).

The substances that were more common (all P<0.0005) among physicians than other suicide victims were:

Antipsychotics, with an odds ratio of 28.7

Benzodiazepines, with an odds ratio of 21.0

Barbiturates, with an odds ratio of 39.5

"The latter is particularly significant because of its infrequent use for therapeutic purposes and its known lethal potential," the researchers noted.

"The equally dramatic increased likelihood of measurable antipsychotics being found is unclear as to its significance, whether they were used for overdosage or because of a significant difference in the prevalence of conditions such as bipolar disorder."

Gold and colleagues cautioned that the available data couldn't distinguish whether the substances were used with lethal intent or contributed to suicide by impairing judgment.

Firearms were the most common method used for suicide by both physicians and nonphysicians, at roughly half in both groups.

Poisoning came in next most common among physician suicides, with a slightly higher proportion than among nonphysicians (24% versus 18%).

Psychosocial risks also differed between the groups.

A job problem that contributed to the suicide was 3.12 times more likely among physicians (P<0.005), whereas death of a friend or family member and crisis in the prior 2 weeks were less common, with odds ratios of 0.37 and 0.61, respectively (P=0.029 and P=0.014).

"Physician self-identity is often centered around the professional role, and this may permeate both work and home aspects of their lives," the investigators wrote. "For someone whose work helps to define his/her personal and professional identity, a crisis in a work situation might feel more threatening than for someone whose personal identity was less reliant on work satisfaction."

They warned that the database used likely underestimated physician suicides and incidence of mental illness because of underreporting and even deliberate miscoding because of the stigma attached.

Other limitations were that the violent death reporting system did not have statewide data for all states and was not a nationally-representative sample.

The researchers reported having no conflicts of interest to disclose.

Gold received salary support from this study from a National Institute of Mental Health grant.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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